Abstract
The aim of this study was to assess quality of life and bowel function in patients undergoing early vs. standard ileostomy closure. We retrospectively assessed patients from our previous randomized controlled trial. Patients with a temporary ileostomy who underwent rectal cancer surgery and did not have anastomotic leakage or other. Early closure (EC; 30 days after creation) and standard closure (SC; 90 days after creation) of ileostomy were compared. Thirty-six months (17–97) after stoma closure, we contacted patients by phone and filled in two questionnaires—The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and low anterior resection syndrome (LARS) score. This index trial was not powered to assess the difference in bowel function between the two groups. All the patients in the SC group had anastomosis <6 cm from the anal verge compared to 42 of 43 (97.7%) in the EC group. There were no statistically significant differences between EC (26 patients) and SC (25 patients) groups in the EORTC QLQ-C30 and LARS questionnaires. Global quality of life was 37.2 (0–91.7; ±24.9) in the EC group vs. 34.3 (0–100; ±16.2) in the SC (p = 0.630). Low anterior resection syndrome was present in 46% of patients in the EC and 56% in the SC group (p = 0.858). Major LARS was found more often in younger patients. However, no statistical significance was found (p = 0.364). The same was found with quality of life (p = 0.219). Age, gender, ileostomy closure timing, neoadjuvant treatment, complications had no effect of worse bowel function or quality of life. There was no difference in quality of life or bowel function in the late postoperative period after the early vs. late closure of ileostomy based on two questionnaires and small sample size. None of our assessed risk factors had a negative effect on bowel function o quality of life.
Highlights
Nowadays advanced, but still potentially curable rectal cancer of the middle and lower thirds are treated with low anterior resection with total mesorectal excision [1]
On the other hand, diverting stoma is associated with low anterior resection syndrome (LARS) because of bowel inflammation caused by altered colonic nutrition, changes in bacterial flora and atrophy of neural terminals in the bowel wall [16]
The aim of this study was to conduct a secondary analysis of our previously published study [17] using two questionnaires—LARS score and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQC30)—to investigate if early (1 month) vs. late (3 months) stoma closure has a different impact on bowel function and quality of life in the late postoperative period
Summary
But still potentially curable rectal cancer of the middle and lower thirds are treated with low anterior resection with total mesorectal excision [1]. Typical stoma closure time is at least three months following the resection [6,7], and it may have a negative impact on additional morbidity and impair quality of life, psychological and emotional state of the patient [8,9]. Many patients following surgery for rectal cancer develop low anterior resection syndrome (LARS) [13,14]. It is thought that neural damage, fibrosis loss of rectal reservoir and altered colonic motility are the main reasons for the development of bowel dysfunction [15]. On the other hand, diverting stoma is associated with LARS because of bowel inflammation caused by altered colonic nutrition, changes in bacterial flora and atrophy of neural terminals in the bowel wall [16]. There is a lack of strong data regarding ileostomy closure time’s effect on quality of life and bowel function
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